Home diabetes kits waste £100m a year, says research

The following correction was printed in the Guardian's Corrections and clarifications column, Thursday April 24 2008

We were incorrect to say in the article below that people with type 2 diabetes are not dependent on insulin injections. Insulin is needed in some cases. The findings from the studies referred to in the article applied only to those patients who do not need insulin to control type 2 diabetes. This was lost during the editing process.

The NHS is wasting more than £100m a year by helping people with diabetes to monitor their condition at home because it only serves to make them anxious, researchers will say today.

For 10 years, doctors have argued over whether blood-glucose monitoring at home is useful for people with type 2 diabetes, the form of the disease often linked to obesity, which is soaring in the UK.

Those with type 2 diabetes are not dependent on insulin injections and can take various measures to help themselves, such as sticking to a careful diet, watching their weight and exercising. Home blood-glucose monitoring, involving a small finger-prick to obtain a drop of blood and a test kit, was introduced to allow people to check on how well they were doing.

Self-monitoring is generally agreed to work for people who are insulin-dependent. But two studies published today in the British Medical Journal reveal a different picture for those who are not.

One of the studies, by Maurice O'Kane and colleagues at Altnagelvin Area hospital , Londonderry, randomly assigned 184 diabetes patients either to self-monitoring or to no monitoring for a year.

The researchers say they were "unable to identify any significant effect of self-monitoring" on glucose levels, the use of medication or hypoglycaemic attacks. Furthermore, they say, the self-monitoring group scored 6% higher on a rating scale designed to assess depression and had "a trend towards increased anxiety".

They suggest this negative effect "might relate less to feelings of powerlessness in the face of high blood-glucose readings than to the enforced discipline of regular monitoring without any tangible gain".

The second study, by Judit Simon and colleagues at Oxford University, looked at cost-effectiveness in a group of 453 patients, randomised to self-monitor or not. They found self monitoring cost up to £92 per patient more than standard care.

In 2004, 1.5 million people in the UK had type 2 diabetes, and the bill for self-monitoring is in excess of £100m a year, the researchers say, and yet it is not cost-effective. The self-monitoring groups did not do better and they "showed reductions in quality of life". The study, they say, "provides no convincing evidence for routinely recommending self-monitoring to patients with non-insulin treated type 2 diabetes".

In an editorial, Martin Gulliford, professor of public health at King's College London, said the £100m cost represented "a substantial opportunity" to invest in other ways of helping people with type 2 diabetes. But the patients' organisation Diabetes UK appeared unconvinced. "Short-term cost savings made by reducing the number of people self-monitoring could be dangerous for the individual and lead to higher costs for the NHS in the long term," warned care adviser Libby Dowling.

A spokesman for the Department of Health said: "Self-monitoring cannot be looked at in isolation."

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